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203: Theme 1: The Endocrine System > Endocrinology of ageing > Flashcards

Endocrinology of ageing Flashcards

1
Q

Age: nutritional status

A

Weight
- increased from mid 30s

Lean body mass
- decrease 6-8%/ decrease from mid 30s

Diet
- trend towards decreased intake total energy and protein with increase age

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2
Q

Age: insulin/ glucose

A

Increased [insulin] and [glucose] with age

  • increased insulin resistance
  • decreased peripheral glucose uptake

Increased prevalence metabolic syndrome with increase age

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3
Q

Menopause

A

Ovarian failure

Oestrogen levels

  • pre-menopausal: cycling
  • post menopausal: very low constant levels

Age at menopause around 50

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4
Q

Symptoms of menopause

A

Hot flushes, night sweats

Median duration of menopause symptoms 7 years

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5
Q

Morbidity of menopause

A

Increase osteoporosis

Increase CHD

Increase sexual dysfunction

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6
Q

Post menopausal HRT

A

Inital observational studies showed benefits

Some subsequent RCTs showed no benefits and increased risks

However risk: benefit ratio depends on

  • other risk factors
  • age of woman and duration of HRT use
  • types of HRT
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7
Q

Post menopausal HRT benefits

A

Rx menopausal Sx

Decreased osteoporosis/ fracture risk

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8
Q

Post menopausal HRT risks

A

Increased venous thrombo-embolism

Increased breast Ca (small)

Increased endometrial Ca

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9
Q

Male gonadal axis

A

Gradual decrease [testosterone] with increase in age

Wide range of normality at all ages

At 75 years, mean [testosterone] 2/3rd that of a 25 year old

Poor association between libido/ erectile dysfunction and [testosterone]

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10
Q

Clinical hypogonadism

A

Decreased sexual function

Increased osteoporosis

Decreased muscle strength

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11
Q

Testosterone treatment; bones

A

Increased bone mineral density if hypogonadal

Bisphosphates work, independent of androgen status

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12
Q

Testosterone treatment: body composition

A

Increase lean body mass

Decrease fat mass

No convincing functional benefits demonstrated

Increased muscle strength with supra physiological doses

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13
Q

Risks of testosterone treatment

A

Prostate (benign prostatic hypertrophy/ cancer)

Erythropoeisis

Possible cardiovascular risk

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14
Q

Potential risks of GH treatment

A

Increased cancer: increase [IGF-I] in observational studies is associated with increased risk non smoking related cancer
- prostate, colon, breast

Increased T2 DM

Side effects

  • soft tissue oedema
  • arthralgias
  • carpal tunnel syndrome
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15
Q

Age: cortisol

A

Increase trough levels cortisol with increase age

Phase advance of diurnal rhythm

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16
Q

Cortisol: sapolsky’s glucocorticoid cascade hypothesis

A

Decreased hippocampal glucocorticoid and mineralocorticoid receptors

Decreased sensitivity to glucocorticoid negative feedback

Increased [glucocorticoids]

Hippocampal neurons vulnerable to damage

17
Q

Importance of DHEA in men

A

Overwhelming excess of more potent circulating androgens

Contribution to androgenic effects in men ‘modest’ at most

18
Q

Decrease in [DHEA] with age

A

By 70-80 years [DHEA] around 5-10% of peak

Observational studies have suggested increase in [DHEA] associated with

  • increase QOL, increase bone mineral density
  • decrease in cognitive decline, decrease in coronary heart disease

Decrease [DHEA] is a non specific marker of ill health
- associations may not be causal

19
Q

Age: thyroid function

A

Slight increase in [TSH] with age

Decrease in peripheral T4 -> T3 conversion with age

Decrease in [T3] with age

No evidence for beneficial effect of T4 treatment

20
Q

Starvation/ AN: insulin, glucose and leptin

A

Decrease insulin and glucose and increase insulin sensitivity

Leptin

  • produced by white adipose tissue
  • reports nutritional information to the hypothalamus
  • decrease leptin leads to increased food intake, decreased energy expenditure and decreased fertility
21
Q

Starvation/ AN: oestrogen/ testosterone

A

Decrease LH and FSH

Decrease oestrogen and testosterone

Decreased fertility, amenorrhoea
- hypothalamic amenorrhoea

Osteoporosis

22
Q

Central mediator: kisspeptin

A

A GnRH secretagogue

KISS1 neurons highly responsive to oestrogen, implicated in both positive and negative feedback of sex steroids on GnRH production

Metabolic influences o reproduction mediated by leptin via the kisspeptin system

23
Q

Starvation/ AN: GH/ IGF axis

A

GH resistance
- increase GH and decrease IGF-I

Seen in acute starvation and in AN

Down regulation of hepatic GH receptor and/ or post receptor defect

Reversible with re-feeding

24
Q

Starvation/ AN: thyroid function

A

TSH and T4 lower limit of normal

Decreased T4 conversion to T3 leads to less T3 (active)

Increase T4 conversion to rT3 leads to increase rT£ (inactive)

Consequences

  • lower basal metabolic rate
  • conserve energy

203: Theme 1: The Endocrine System (22 decks)

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